System and method for documenting patient procedures

ABSTRACT

The local surveillance sub-system recognizes that a patient medical procedure has or will soon commence by sensing the presence of a healthcare professional in or near the surveillance area, and in response, creates a separate patient medical procedure A/V file for the surveillance data that will be captured. A dedicated procedure remote may be provided for receiving manual interactions from HC professionals present for a procedure or, alternatively, the local surveillance sub-system may autonomously interact with a personal security token device possessed by the HC professional. A procedure data file is also created that holds all of the pertinent information concerning the procedure that is known by the local surveillance sub-system. The patient procedure surveillance A/V file is given a higher priority than ordinary surveillance data captured by the local surveillance sub-system and is then copied to a nonvolatile memory that is separate from the primary memory of the surveillance sub-system. The local surveillance sub-system captures surveillance A/V data that is copied to the nonvolatile memory until the system senses that the procedure has ended, when an end-of-procedure message is transmitted across the HCF distribution network. The corresponding patient medical procedure surveillance A/V file resides in a local nonvolatile memory until it can be downloaded to a central storage at the healthcare facility.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is related to and claims the benefit of priority toU.S. provisional patent application No. 61/119,355 filed Dec. 2, 2008,entitled System and Method for Documenting Patient Procedures. Thisapplication is also related to U.S. patent application Ser. No.10/735,307, now U.S. Pat. No. 7,477,285 issued Jan. 13, 2009, entitledNon-Intrusive Data Transmission Network for Use in an EnterpriseFacility and Method for Implementing, U.S. patent application Ser. No.12/151,452 filed May 6, 2008, entitled System and Method for PredictingPatient Falls and to System and Method for Documenting PatientProcedures. Each of the above identified patents and patent applicationsis assigned to the assignee of the present invention. Each of the aboveidentified patent and patent applications is incorporated by referenceherein in its entirety.

BACKGROUND OF THE INVENTION

The healthcare industry is a complicated, highly regulated industry thatprovides a product for serving every type of human condition in everycombination possible. As such, detailed documentation of patientdiagnosis, conditions, treatments, procedures and the frequency and timeof each is mandatory.

Contrary to general belief, a hospital is not paid based on what thedetailed bill indicates. Hospitals are generally paid on a DiagnosticRelated Group (DRG) which is based on the patient's diagnosis that wasthe primary reason for admission to a hospital, complications involvedwith the patient's condition and/or during the patient's hospitalizationand procedures performed during the hospitalization. Each different DRG(there are over 500) provides for different reimbursement. Furthermore,within a “grouping”, there are different sub-categories of reimbursementthat are driven by the complications and treatment of thosecomplications.

As an example, assume a patient is admitted to a hospital for congestiveheart failure (CHF) and arrived from a nursing home with decubitusulcers (bed sores). The patient's diagnosis would be CHF withcomplications, decubitus ulcers. Reimbursement for CHF with nocomplications would be one amount, for instance $4,000.00; reimbursementfor CHF with complications would be an additional amount, for instance$2,000.00 or a total of approximately $6,000.00. However, documentationmust be provided to support coding that this type of ulcer did exist andwas treated. Treatment for bed sores is a combination of continuallymoving the patient to avoid the sores getting infected and may result ina bedside debridement (removal of the ulcer at the bedside).Documentation is generally provided in the form of the nurse rememberingwhat was done at the bedside and then memorializing the medicalprocedure that was performed at the bedside in the patient's medicalrecord (paper or electronic) upon returning to the nursing station.

From the time a nurse leaves the nursing station, enters a patient'sroom, performs treatment, returns to the nursing station and documentsthe events that took place in each patients room, many opportunities fordisruption and interruption can transpire. Some studies suggest that upto thirty-eight percent (38%) of healthcare provider billings do nothave complete coding and supportive documentation, thereby reducingreimbursement for that particular patient's admission and causing theentire system to subsidize these shortfalls in reimbursement.

Starting in October 2008, the Center for Medicare and Medicaid Services(CMS) (the Medicare program) will no longer reimburse hospitals forerrors or non-events that took place during the patients stay. Using thesame example of the patient with CHF and bed sores discussed above, itwill now be necessary to document that fact that the patient had thiscondition “before” arriving at the hospital and was not caused by thehospital. CHF is easily proven to the satisfaction of CMS (fluid in thelungs, EKG tests, enzyme testing), but it is not unusual for elderlypatients to develop bed sores if they have been lying in a bed for anextended period of time in the same position. However, it is much moredifficult to document conditions such as bed sores that might develop ineither facility. Care must be taken to meticulously document everyexisting condition that might require treatment during the stay at thefacility, whether or not that condition is the primary reason for thepatient being admitted to the facility.

Finally, it has been reported that insurers and CMS routinely requireadditional support for medical procedures and charges documented on thepatient's bill. Some of those procedures may even require supplementalsupporting documentation to corroborate the medical procedures andcharges. In addition, up to 20% of all charged items are routinelydisallowed by insurers and CMS, essentially without comment or anyexplanation. It is then up to the healthcare facility to providepersuasive documentation in support of the medical procedures andcharges. In most cases, the only support can be found in the medicalrecords, which may have already been submitted. In the vast majority ofcases, the only type of supplemental supporting documentation that canbe proffered is a written description of the medical procedures by aphysician or charge nurse. Documentation that is not temporal with amedical procedure is by far the least persuasive type of support thatcan be provided.

Aside from patient billing matters, the quality of patient care isalways best when all the facts are known and documented. Physicians relyon this documentation to become knowledgeable of the patients condition,improvement or deterioration, and the frequency of events andtreatments. They need 100% of the information . . . not 62% of theinformation. If the written patient record is incomplete or unavailable,the quality of patient care may suffer.

BRIEF SUMMARY OF THE INVENTION

The present invention is directed to a system, method and softwareproduct for documenting patient medical procedures. The presentinvention relates to a patient surveillance system comprising at leastvideo and audio documentation applications that allows a healthcarefacility to automatically document a medical procedure with surveillanceA/V data and to direct a copy of the A/V to a nonvolatile local memory.The local surveillance sub-system constantly captures video and/or audiodata from the surveillance area in, for instance, a patient room, andtransmits that data to a monitoring station on the HCF distributionnetwork. That surveillance A/V data may be used for documenting patientmedical procedures, but present volumes of information that must besearched for a particular A/V sequence needed for documentation.

Initially, the present patient medical procedure documentation systemsenses the presence of a healthcare (HCF) professional in or near thesurveillance area. The “sensing” may be autonomously via a transponderidentification device in the possession of the HC professional, or maybe manually invoked by the HC professional. A dedicated procedure remotemay be provided for receiving manual interactions from HC professionalspresent for a procedure. The local surveillance sub-system recognizesthat a patient medical procedure has or will soon commence and creates aseparate patient medical procedure A/V file for the surveillance datathat will be captured. A procedure data file is also created that holdsall of the pertinent information concerning the procedure that is knownby the local surveillance sub-system. That data file can be edited oramended at any time locally by the HC professional(s) present for theprocedure. The patient medical procedure surveillance A/V file isprioritized higher than ordinary surveillance data captured by the localsurveillance sub-system and retained in a nonvolatile memory that isseparate from the primary memory of the surveillance sub-system. Thelocal surveillance sub-system captures surveillance A/V data that iscopied to the nonvolatile memory until the system senses that theprocedure has ended. The end of a procedure may be signified by acommand from an HC professional present or by the expiration of apredetermined time period, or by the local surveillance sub-system notdetecting any movement in the surveillance area for a predetermined timeperiod. Then, an end-of-procedure message is transmitted across the HCFdistribution network. The corresponding patient medical proceduresurveillance A/V file resides in a local nonvolatile until it can bedownloaded to a central storage at the healthcare facility.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

The novel features believed characteristic of the present invention areset forth in the appended claims. The invention itself, however, as wellas a preferred mode of use, further objectives and advantages thereof,will be best understood by reference to the following detaileddescription of an illustrative embodiment when read in conjunction withthe accompanying drawings wherein:

FIG. 1 is a flowchart of a generic process for documenting a medicalprocedure using the patient surveillance system in accordance with oneexemplary embodiment of the present invention;

FIGS. 2A and 2B are top and oblique views, respectively, of a medicalprocedure remote interface for initiating a medical proceduresurveillance A/V data file which requires minimal interaction from a HCprofessional in accordance with one exemplary embodiment of the presentinvention;

FIG. 3 is a diagram of a pillow speaker with integrated medicalprocedure interface functionality for providing detailed information topresent patient medical procedure documentation system for initiating amedical procedure surveillance A/V data file in accordance with oneexemplary embodiment of the present invention;

FIG. 4 is a diagram of the logical components used in the presentpatient medical procedure documentation system in accordance with stillanother exemplary embodiment of the present invention;

FIGS. 5A and 5B are views of a patient room with the present patientmedical procedure documentation system and hand cleaning/disinfectantstation, respectively, in accordance with one exemplary embodiment ofthe present invention;

FIGS. 6A and 6B are diagrams showing the positioning of a handcleaning/disinfectant station with a medical procedure remote inaccordance with an exemplary embodiment of the present invention;

FIG. 7 is a diagram of an exemplary healthcare facility in which thepresent patient medical procedure documentation system may beimplemented;

FIG. 8 is a logical diagram that illustrates the flow of surveillancevideo data across surveillance system 420 for documenting patientmedical procedures in accordance with an exemplary embodiment of thepresent invention;

FIGS. 9A and 9B are a flowchart of a process for documenting patientmedical procedures using a surveillance system in accordance with anexemplary embodiment of the present invention;

FIG. 10 is an illustration of a patient procedure screen for the presentpatient medical procedure documentation system that may be accessed byauthorized HC professionals in accordance with an exemplary embodimentof the present invention;

FIG. 11 is a flowchart of a process for collecting the documentationsurveillance A/V files corresponding to a patient medical procedure inaccordance with an exemplary embodiment of the present invention; and

FIG. 12 is a flowchart illustrating a process for documenting patientmedical procedures using surveillance A/V files corresponding to thepatient medical procedure in accordance with an exemplary embodiment ofthe present invention.

Other features of the present invention will be apparent from theaccompanying drawings and from the following detailed description.

DETAILED DESCRIPTION OF THE INVENTION

Element Reference Number Designations 200: Procedure remote 202:Identification buttons 210: Transmitter 275: 300: Medicalprocedure/pillow speaker interface 302: User interface 303: Statuslights 304: Nurse call button 306: Room lighting 308: Speaker 310:Transmitter/connector 400: Patient room 410: Camera control device 411:Processor unit 412: Network controller 413: Video processor 414: Primarynonvolatile memory 415: Secondary nonvolatile memory 416: Video camera417: Video monitor 418: Receiver interrogator and medical procedureremote interface 420: Local surveillance sub-system 430: Autonomoussensing device 440: Distribution network 450: Nurse station 460: Nursemonitor device 461: Processor unit 462: Network controller 463: Videoprocessor 464: Primary nonvolatile memory 465: Secondary nonvolatilememory 466: Video camera 467: Video monitor 468: Audible alarm 469:Manual interface device 470: Monitor sub-system 502: Bed 504: Furniture506: Lavatory 510: Hand cleaning/disinfectant station 512: Germicidaldisinfectant 514: Protective gloves 516: Wipes 518: Station table 520:View angle 700: Procedure interface 710: Computer (PC, laptop, netdevice) 741: Transmission medium 742: Network switch 743: Broadbandconnection 744: Network storage 745: Patient administration 746: Networkserver/router/firewall 748: Network system administration 800: Procedureremote interface

In the following description, reference is made to the accompanyingdrawings that form a part hereof, and in which is shown by way ofillustration, specific embodiments in which the invention may bepracticed. These embodiments are described in sufficient detail toenable those skilled in the art to practice the invention, and it is tobe understood that other embodiments may be utilized. It is also to beunderstood that structural, procedural and system changes may be madewithout departing from the spirit and scope of the present invention.The following description is, therefore, not to be taken in a limitingsense. For clarity of exposition, like features shown in theaccompanying drawings are indicated with like reference numerals andsimilar features as shown in alternate embodiments in the drawings areindicated with similar reference numerals.

Accurate documentation of patient information is critical to ahealthcare facility (HCF) and is a primary responsibility of anyone whocomes in contact with a patient. Traditionally, these professionalsinclude doctors, nurses, healthcare specialists and administrativeprofessionals. As used throughout hereinafter, the term healthcare (HCF)professional will synonymously for any healthcare practitioner that mayfrequent an patient's room of a healthcare facility, includingtechnicians, general facilities staff, housekeeping staff, nurse'saides, etc., in addition to those HC professionals identified directlyabove. Almost as importantly, that documentation should readily beavailable to HCF administrators. The types of patient events thatnecessitate documenting include patient movement, especially movementsoutside the prescribed bounds, the presence or absence of persons in apatient room, medical procedures, therapy, housekeeping, counseling andconsultations. Typically, documentation is in the form of written oraudio records that are transcribed into the patient's records.

Recently however, HCFs have begun placing video surveillance equipmentin patient areas such as examination rooms, therapy rooms and patientrooms, corridors and even lavatories. Conventionally, during operationthis equipment generates huge volumes of surveillance A/V data that mustbe transmitted over existing networks to a remote monitoring stationand, if necessary, to dedicated storage servers. The bandwidth of mostHCF distribution networks is usually insufficient for carrying both thenormal data traffic for the healthcare facility and surveillance A/Vdata. Hence, even though a patient surveillance device may be in thepatient's room, it cannot necessarily be relied on due to networkbandwidth constraints. This shortcoming has been addressed in U.S.patent application Ser. No. 10/735,307 to Johnson entitled Non-IntrusiveData Transmission Network for Use in an Enterprise Facility. There, theprimary surveillance data transmission medium is an existing coaxialCATV network. Hence, the coaxial CATV network carries surveillance dataas well as CATV programming. A set-top control device and surveillancecamera control device replaces, or is integrated in the traditional CATVset-top box in the patient rooms. The set-top control device arbitrateswith the coaxial network for transmitting A/V data captured in theindividual patient rooms. Even using the coaxial network forsurveillance traffic does not guarantee that the network is up andavailable for A/V traffic, or has the bandwidth capacity to carry all ofthe surveillance data collected from each patient room. Therefore, theset-top control device is configured with a video processor and a localmemory for varying the transmission rates on the coaxial network and, ifnecessary, for storing the surveillance data locally for retrieval inthe future. These improvements greatly increase the available networkbandwidth to accommodate more surveillance data and the likelihood thatthe data are available even after the coaxial network goes down.

Aside from the problem of available network bandwidth, anothershortcoming of prior art patient surveillance systems is that theycannot distinguish between pertinent surveillance data and surveillancedata that is less important. Some type of surveillance data may havemore significance than others, but without some mechanism fordiscriminating data, all surveillance data is equally important to thesurveillance system. U.S. patent application Ser. No. 12/151,452 filedMay 6, 2008, entitled System and Method for Predicting Patient Fallsdescribes a set-top control device that contains intelligence thatenables the video processor to discriminate video data that is of lowimportance, such as sequential video frames without motions. Thesurveillance system is further improved by implementing a patient fallprediction system in the set-top control devices of HCF's existingsurveillance monitoring system. The prediction system not only moreaccurately discriminates important surveillance A/V data from data oflesser importance for efficiently allocating storage space andtransmission bandwidth, it also provides a means for triggering an alarmwhen the patient traverses high risk areas, such as the edges of a bedor chair, the side of a tub, a shower entry, or even an entrywaythreshold. While each of these inventions solve a particular problemfacing the healthcare industry, the dilemma of accurately documentingpatient event data in a manner that it is easily accessed by an HCFadministrator has not yet been addressed.

The present invention provides a mechanism that is seamlesslyincorporated into an HCF's surveillance system for identifying importantpatient events, documenting them with surveillance A/V data and savingthe surveillance A/V files to a local storage, along with thecorresponding identification data, for future retrieval. Moreover, aswill be discussed below, in many embodiments the present patient medicalprocedure documentation system operates autonomously, without manualintervention. This is highly desirable as it provides an additionalmeasure of documentation over the written patient records prepared bythe healthcare provider, with little or no input from the HCprofessionals that are present during the procedure.

Essentially, the present patient medical procedure documentation systemrecognizes that a HC professional (or a HCF procedure provider) ispresent in a surveillance area and creates a separate data file for allsurveillance A/V data collected while the HC professional is present. Ata threshold level, the present patient medical procedure documentationsystem senses the presence of a HC professional and begins a medicalprocedure A/V data file associated with the professional. The mere factthat a stream of surveillance data can be distinguished from all otherdata by the presence of the HC professional greatly reduces the workloadof ferreting through endless streams of A/V data for documentation of amedical procedure.

Optimally, the present patient medical procedure documentation systemidentifies the HC professional by her job title/description/position,name or employee number and writes that information to an A/V file. Thisinformation further simplifies the task of identifying a particular A/Vdata stream associated with a particular procedure because in most casesthe identity of the HC professional for the procedure is known,consequently the A/V record need only be searched for data where theparticular HC professional is present. Here, it should be mentioned,that although the captured surveillance data is expected to be in theform of audio and video media, it may instead be one or the other. Stillfurther, the present patient medical procedure documentation system mayprovide a mechanism for the HC professional, or some other person, tobind an A/V data file with all data that is pertinent to the medicalprocedure. For instance, a separate interface device for enteringadditional data that might be used to, for instance, search fields orkeyword identifiers for sorting A/V data files. The types of data vary.For instance, the type of procedure, its billing code, the identity ofthe HC professional present and employee number, the identities of HCFpersonnel present (in addition to the HC professional who performed thepatient procedure), comments by the HC professional made before, duringor after the procedure and even a separate audio tract by the HCprofessional to be transcribed into the medical record (as opposed to,or in addition to, the current practice of the HC professional creatinga separate audio tape from the written patient record that is latertranscribed into a formal medical record).

Furthermore, in accordance with some aspects of the present invention,the present patient medical procedure documentation system will writethe data collected from the surveillance area to a file of streaming A/Vdata, or in accordance with other aspects of the present invention, thedata collected from the surveillance area may be appended to each imageframe, audio packet or other convenient subdivision of the A/V datastream.

In any case, the present patient medical procedure documentation systemsupplements more permanent data relating to the surveillance area withmore transient information that is indicative of an important patientevent, such as a medical procedure. For instance, a patient monitoringdevice may be permanently disposed in the patient rooms of an HCF. AllA/V data captured in the respective patient rooms is labeled withlocation information, such as a room number or area designation and atimestamp. Hence, any surveillance data saved by the system may beretrieved by the location of the surveillance camera and time. Whilethis provides a minimal filter for discriminating surveillance data, theamount of time necessary for a HCF administrator to ferret out A/Vdocumentation for a particular procedure may be quite extensive. Inaccordance with one exemplary embodiment of the present invention, thepresent invention further binds the A/V data with information relatingto the status of the HC professional present in the surveillance area.Ideally, that information identifies the HC professional's job title ordescription or her position with the HCF. Detecting the presence of anidentifiable HC professional in an A/V data stream greatly reduces theamount of time that is necessary for finding A/V documentation for aparticular medical procedure. Most procedures require the presence of anHC professional with a particular skill set. For instance, if anadministrator needs documentation that a particular patient receivedpreventative care for bedsores, the administrator merely selects thesurveillance A/V files from the patient's room when an aide, nurse orphysician was present. Alternatively, if the administrator needs to knowthe time and frequency of a patient having his blood pressure checked,the administrator may instead access all surveillance A/V files from thepatient's room in which a nurse or physician was present, more likely anurse. Documentation for more complicated medical procedures thatrequire the presence of a physician are easily retrieved from the A/Vrecord by filtering files in which a physician was present. Obviously,without labeling A/V surveillance files with the procedureidentification, it may be necessary for the administrator to reviewseveral data files for one documenting the target procedure, however,the amount of data to be reviewed is reduced from hours to, perhaps, avery few minutes when an HC professional qualified to administer theprocedure is present.

In accordance with still another exemplary embodiment of the presentinvention, each time the present patient medical procedure documentationsystem senses the presence of an HCF in or near the surveillance area,it automatically saves the A/V data stream to a local, nonvolatilememory and flags it as a protected file. As such, that data is given ahigher priority from overwriting. This procedure has two features thatprotect potentially important surveillance A/V data from deletion. Firstit removes the data from the control of the network transmission arbiterand second, it ensures that at least one documentation copy of theprocedure is warehoused, at least semi-permanently. Conventional networksurveillance systems attempt to transmit all captured surveillance A/Vdata to a central retention server in real-time. Often there is nocontingency other than overwriting the data if the network or servercannot accept the data in near real-time.

More particularly, the patient surveillance system of the presentpatient medical procedure documentation system generally comprises twoseparate nonvolatile memories. The first is a smaller capacity memoryfor temporarily storing video data frames (and the associated audio)prior to network transmission, between video processing stages andduring, such as a solid state flash memory. The second memory is also anon-volatile memory but has a much larger capacity. The primary reasonfor bifurcating the memory is cost. While the entire memory may beconstructed of a non-volatile solid state memory, it is simply tooexpensive of a medium for storing the amount of A/V surveillance datathat must reside locally. For this reason the second memory is usually ahard drive. In either case, the A/V surveillance data residing in thesecond memory is available for downloading locally via the patientsurveillance system or remotely over the network.

Still more particularly, the patient surveillance system of the presentpatient medical procedure documentation system comprises data and videoprocessing capacity for detecting, sensing or identifying videosequences associated with a medical procedure and then to bind those A/Vdata sequences with information that is pertinent to the procedure. Thatinformation is usually obtained simultaneously with detecting orsensing. In accordance with one exemplary embodiment of the presentinvention, the patient surveillance system senses the presence of a HCprofessional in or near the surveillance area. The patient surveillancesystem may comprise a transceiver or interrogator for sensing thepresence of a particular type of security token, i.e., a small hardwaredevice with built-in authentication mechanisms unique to the possessorof the device. In that case, the HC professional carries a compatiblesecurity token device, such as transponder key FOB, RFID assetmanagement, Bluetooth or the like. In sensing the presence of the HCprofessional, the patient surveillance system interrogates the securitytoken for information about the holder, such as the identity of itsowner, employee number, position, status, authority and security level,etc. It should be mentioned that the security token may activelytransmit security information and/or negotiate with thetransceiver/interrogator or may instead be a passive device that isinterrogated by the transceiver/interrogator or, alternatively, be acompletely passive device that generates security keys that must bemanually entered to the patient surveillance system by a HCFprocessional that is present for the procedure.

The patient surveillance system is constantly monitoring thesurveillance area in a patient's room by video and perhaps audio capturedevices. As might be appreciated, this type of surveillance creates aninordinate amount of data associated with any single patient's stay in ahealthcare facility. Multiply that amount of surveillance data by thenumber of patient rooms, examination rooms, emergency stations andmedical procedure rooms and it becomes evident that maintaining thesurveillance data requires the instantiation of a new department solelyfor handling the electronic surveillance data. Furthermore, it isdoubtful that any facility's IT, except possibly the smallest healthcarefacility, could provide the network bandwidth that is necessary tosupport transmission of the surveillance data to a central data storage.Even assuming these problems could be overcome, searching the globalmass of surveillance data for documentation of a single (or group) ofmedical procedures for a patient would require hours of viewing time bya qualified professional for identifying the surveillance record for aparticular patient and then viewing the patient's surveillance recordfor evidence of a particular medical procedure.

The present invention overcomes the shortcomings discussed above byidentifying surveillance data for a patient as tentatively being medicalprocedure documentation and then taking extraordinary measures forprotecting the medical procedure documentation. FIG. 1 is a flowchart ofa generic process for documenting a medical procedure using the patientsurveillance system depicted in FIG. 4, which incorporates several inputdevices for the delineating the medical procedure documentation fromother surveillance data captured by a patient surveillance system. FIGS.2A, 2B and 3 depict exemplary interface devices for identifyingsurveillance data as being associated with a medical procedure and forentering information pertinent to the procedure to the surveillancedata.

Before discussing the devices and methodology of the present invention,it should be mentioned that the healthcare professionals, like anyoneelse, are more likely to embrace a new technology or procedure thatentails little or no learning and requires little or no extra effort inusing. Hence, the present patient medical procedure documentation systemmay be implemented as a completely passive system in which the patientmedical procedure documentation system makes all decisions regarding theidentification of medical procedure surveillance data. Alternatively,the present patient medical procedure documentation system may beimplemented as a more active system in which the healthcare professionalmust interact with the system for inputting certain data regarding theidentification of medical procedure surveillance data and/or theidentity of the HC professional(s) present or other data pertinent tothe procedure. In general, however, the present patient medicalprocedure documentation system may require some type of humaninteraction for providing pertinent information that identifies the typeof medical procedure and/or the HC professional(s) present during themedical procedure. However, much of this interaction may be accomplishedbeforehand by inputting the data to the system at a remote location. Theinputted data is then stored at the local patient surveillance system inthe patient's room, or the like, until the procedure is performed. Stillanother alternative is for the HC professional to initiate the creationof a medical procedure surveillance file and manually enter thenecessary data pertaining to the procedure. These and other features ofthe present invention will become clear with the description of thefigures.

Turning to FIG. 1, a flowchart is illustrated that shows a genericprocess for providing documentation of a medical procedure in accordancewith an exemplary embodiment of the present invention. The process isexecuted within the patient medical procedure documentation system andmore particularly the entire process may be executed within a localcamera control device of the system, such as that depicted in FIG. 4.The local camera control device may be embodied as part of a set-top boxas described in copending U.S. patent application Ser. Nos. 10/735,307and 12/151,452, or instead may be embodied in a dedicated patientsurveillance system, or the like. In either case, one function of thesystem is to identify portions of the surveillance video (or audio)stream for a medical procedure and to protect that data as a local A/Vdata file that can be accessed anytime thereafter. As a thresholdmatter, most HCF's would prefer that any ambiguous A/V be treated asmedical procedure data, protected and saved locally for manual (visualor audio) inspection. In that way, the HCF can be guaranteed that allmedical procedure documentation is retained, while simultaneouslyreducing the amount of A/V data that must be manually inspected.

The process begins by the patient medical procedure documentation systemdetecting the presence of an HC professional (step 102). The system maysense the presence of an HC professional through a personalidentification device, for instance by autonomously interrogating asecurity token device, transponder key FOB, an RFID asset managementdevice, a Bluetooth device or the like that is carried on the HCFpersonnel. Alternatively, the system may sense the presence of an HCprofessional through manual interaction of a specialized medicalprocedure interface device. In either case, the system is alerted of thepresence of a HC professional in or near the surveillance area thatmight indicate that a patient medical procedure is to commence.Optionally, the process identifies the HC professional by name,position, status and/or by ID, employee or badge number (step 104). Asmay be appreciated, at times more than one HC professional will bepresent. In the autonomous mode, optimally the present patient medicalprocedure documentation system will create a hierarchy of HCprofessionals that are present and associate those professionals to allpossible patient medical procedures that are authorized by the group. Ifno other information related to the medical procedure can be ascertainedby the system, the A/V data file will at least provide enoughinformation to narrow a search to a certain medical procedures, therebygreatly reducing the amount of A/V surveillance data that must beinspected manually.

Optimally, the type of medical procedure to be performed can beidentified by the system (step 106). That information may be enteredmanually by the attending HC professional or selected from a list ofprocedures that are authorized by the highest ranking attending HCprofessional. Alternately, the identity of the procedure may be inferredfrom the rank or status of the attending HC professional. Hence, byaccurately detecting the presence of an identified HC professional, thepresent patient medical procedure documentation system can autonomouslydetermine which types of medical procedures, if any, that the HCprofessional is authorized to perform. For example, upon detecting thepresence of only a nurse's aide, the present patient medical proceduredocumentation system will correlate the status of a nurse's aide to themedical procedures authorized to be performed by the aide.Alternatively, if the highest ranking HC professional detected by thesystem is a nurse with RN status, then the present patient medicalprocedure documentation system will correlate the status of a registerednurse to the medical procedures authorized to be performed by an RN. Theaim here is to eliminate all medical procedures that are not authorizedto be performed by the HC professional present with the highest rank.

With at least information inferring the presence of HC professionals,the present patient medical procedure documentation system creates anA/V data medical procedure file for the upcoming stream of A/V data(step 108). A file header is created for the new patient medicalprocedure and all pertinent information concerning the procedure isincluded (step 110). From this point forward, all A/V data captured bythe present patient medical procedure documentation system is treated asproprietary in the local memory over many other types of A/V data filesstored to the system. This is important because the local camera controldevice comprises a finite amount of storage capacity. A/V data storedonto that system should be prioritized for efficient storage of A/Vdata. The aim is to retain high priority A/V data for future access,while overwriting lower priority data with more temporal A/V data and/orhigher priority A/V data. A hierarchy of file types may be created forprioritizing the A/V data files. For instance, surveillance A/V data maybe assigned the lowest priority, but surveillance A/V data in whichmotion is detected might be given a higher priority (see for instancecopending U.S. patent application Ser. Nos. 10/735,307 and 12/151,452).A/V data files for documenting a patient medical procedure may be givenan even higher priority. Hence, as memory space is needed for newsurveillance A/V data, the present patient medical proceduredocumentation system compares the priority of the newly captured A/Vdata with that in the local memory for allocating storage space.Moreover, the file hierarchy may extend to prioritizing types of medicalprocedures, for instance, a patient rotation to prevent bedsores mayhave a lower priority than an EKG or another medical procedure that canonly be performed by a physician or medical specialist. In any case, thepresent patient medical procedure documentation system is flexibleenough to enable the attending HC professional to modify the informationin the medical procedure surveillance A/V file header at anytime untilthe A/V medical procedure data file is bound.

Once a medical procedure A/V data file has been created, the presentpatient medical procedure documentation system monitors the procedureand captures audio and/or video to the A/V data file (step 112). Eachcaptured video frame is immediately copied to a secondary local memoryin the camera control device (step 114). An exemplary embodiment of thelocal camera control device will be discussed below with regard to thedevice illustrated in FIG. 4 below. However optimally, the secondarymemory is a nonvolatile memory that accommodates moderate transferspeeds, such as a flash memory or an optical hard drive, with thecapacity for storing several hours of A/V data. The aim is to providememory space for temporarily storing medical procedure A/V data filesand the associated header data. The storage architecture should providethe medical records personnel with the means for accessing the secondarymemory and identifying specific medical procedure A/V data files storedthereon. As may be appreciated, other types of memory may also be used,such as an optical drive for writing to CD or DVD media, but accessingthe data files thereon may be more manually intensive.

In any case, the present patient medical procedure documentation systemcontinues writing A/V data to the open medical procedure A/V data fileuntil the system detects an end to the medical procedure (step 116). Thepresent patient medical procedure documentation system invokes aprocedure end detection sub-process that continually tests for an end tothe procedure. The procedure end detection sub-process may take one ofmany forms, such as by receiving a manual command from the HCprofessional to terminate the medical procedure A/V data file, or bydetecting the end of a predetermined time period, or by failing todetect any motion in the surveillance area for a predetermined timeperiod, or any combination of the sub-processes described above. Oncethe present patient medical procedure documentation system detects thatthe medical procedure has ended, it binds the medical procedure A/V datafile with the header information and transmits the header informationover a network to a medical records database for permanent storage (step118). A data file containing some or all of the patent procedure datamay then be transmitted across the HCF distribution network. Receivingan end-of-procedure message, or in fact any header informationconcerning a patient medical procedure, indicates that the set-top boxin the patient's room may contain a medical procedure surveillance A/Vdata file related to the procedure file, and hence should be promptlydownloaded before it can be overwritten with more temporal surveillanceA/V data. Typically, the medical records database is under the controlof the system administrator, but is usually accessible by the HCFmedical records and patient billing departments. Once the headerinformation is received by the system administrator, the administratorcan schedule a time for downloading the medical procedure documentation,usually during off-peak hours.

As discussed immediately above, one novel feature of the present patientmedical procedure documentation system is the ability to sense thepresence of an HC professional that may indicate the commencement of amedical procedure. In so doing, the present patient medical proceduredocumentation system immediately creates a medical procedure A/V datafile using audio and/or video that is captured by a patient surveillancesystem. The medical procedure A/V data file created by the patientsurveillance system is securely saved to a local nonvolatile storageuntil it can be downloaded over the HCF network to a central medicalrecords database. As also discussed, these sensing devices may bebifurcated into manual and autonomous sensing device categories. Of thetwo categories, the autonomous sensing devices are preferred as theyrequire little or no manual interaction by the HC professional presentduring the patient medical procedure and, therefore, present lessopportunity for the omission of documenting a patient medical procedure.The autonomous sensing devices usually require that HCF personnelpossess a personal identification device, such as a transponder key FOB,an RFID asset management device, a Bluetooth device or the like, thatcan be interrogated for the owner of the personal identification deviceby the present patient medical procedure documentation system incooperation with the patient surveillance system. Ultimately, an optimalsensing device is a facial recognition routine embodied on the patientsurveillance system that autonomously recognizes HC professionals thatare present in the patient surveillance area of the patient's room(i.e., a facial biometrics recognizer).

Manual sensing devices, on the other hand, may include legacy manualinput devices such as keyboards, mice, trackballs, pointers, etc,(optimally utilizing wireless transmission technology such as RF,Bluetooth or IR). The use of these legacy manual input devices requiresignificant interaction by the HC professional through one or more videodisplay screens for creating a medical procedure A/V data file and/ormerely identifying herself as being present in the patient surveillancearea (resulting in the present patient medical procedure documentationsystem automatically creating a medical procedure surveillance A/V datafile). Hence, these types of devices are particularly problematic in abustling HCF environment, especially for higher level HC professionalssuch as physicians, medical specialist and the like. Therefore, inaccordance with still another exemplary embodiment of the presentinvention, a medical procedure remote interface is provided whichrequire minimal interaction for the HC professional, while providingenough information to the present patient medical proceduredocumentation system for the instantiation of a medical procedure A/Vdata file.

FIGS. 2A and 2B are top and oblique views, respectively, of a medicalprocedure remote interface for initiating a medical procedure A/V datafile which requires minimal interaction from a HC professional inaccordance with one exemplary embodiment of the present invention.Procedure remote interface 200 is essentially a remote interface devicethat is linked to the present patient medical procedure documentationsystem for detecting the presence of a HC professional who is in or nearthe patient surveillance area. Although the present medical procedureremote interface may be implemented in numerous configurations, thebasic requirements of the device are to identify some type ofinformation that may indicate the commencement of a patient medicalprocedure and to communicate that information to the present patientmedical procedure documentation system.

Exemplary medical procedure remote interface 200 utilizes severalmanually interactive buttons which are separately labeled with someinformation relating to a patient medical procedure. In the exemplarydevice, buttons 202 are labeled “PHYSICIAN,” “NURSE,” SPECIALIST″ and“STAFF” for identifying HC professionals that are in the surveillancearea and separate “RECORD” and “END” buttons for creating andterminating a medical procedure surveillance A/V data file. Hence, ifPHYSICIAN button is depressed, medical procedure remote interface 200communicates that information to the present patient medical proceduredocumentation system. In turn, a medical procedure A/V data file iscreated which identifies a physician as being present in the patient'sroom.

Interface buttons 202 may be tactile or disposed on a touch screen, oralternately the manual interface of medical procedure remote interface200 may be any highly simplified interface device such a single humaninterface that detects some predefined interaction by a HC professionalsuch as a manual (or virtual) actuator, switch, lever, knob, etc., or abiometric sensor such as a voice recognizer, fingerprint reader, wholehand scanner, iris/retina recognizer, as well as a facial biometricsrecognizer used in conjunction with medical procedure remote interface200.

Also shown on medical procedure remote interface 200 is transmitter 210for communicating with the base station portion of the patientsurveillance system (i.e., a camera control device or the like). Itshould be appreciated that transmitter 210 is internal or barely visibleon medical procedure remote interface 200. In practice, transmitter 210may actually be a transceiver for bidirectional communication with thepatient surveillance system. Transmitter 210 may operate in any wirelessprotocol, for instance RF, IR, Bluetooth, or even WIFI or WIFI ProtectedAccess (WPA), legacy IEEE 802.11 or one of the evolving wireless designstandards, i.e., IEEE 802.11x.

One shortcoming of medical procedure remote interface 200 discussedabove is that it provides little information concerning the patientmedical procedure. While this information is sufficient to create andprotect a medical procedure A/V data file on a local memory, it lacksthe specificity necessary that is required for a HCF billingprofessional to query the HCF medical records database for a specificmedical procedure for a specific patient. Therefore, in accordance withstill another exemplary embodiment of the present invention, a pillowspeaker with an integrated medical procedure interface is disclosed.FIG. 3 is a diagram of a pillow speaker with an integrated medicalprocedure interface functionality for providing detailed information topresent patient medical procedure documentation system for initiating amedical procedure A/V data file. Pillow speakers are well known in theprior art as being an A/V device tethered to both the patient'stelevision and the nurse station. Conventional pillow speakers comprisea handheld unit with a speaker and usually some rudimentary televisioncontrols, e.g., channel changer, speaker volume control and an ON/OFFswitch. Some more advanced prior art pillow speakers include a channelselector and often a nurse call button. By contrast, the present medicalprocedure/pillow speaker interface 300 comprises user interface 302 witha multiplicity of buttons for selecting CATV television channels,adjusting the volume of speaker 308, and for entering copious amounts ofinformation to the present patient medical procedure documentationsystem. Typically, medical procedure/pillow speaker interface 300 iswired to the HCF's CATV and surveillance networks by wired tether 310(this is primarily due to the high power consumption of speaker 308 and,therefore, can be eliminated in favor of a wireless connection if thespeaker function is eliminated). As the presently described patientsurveillance and patient medical procedure documentation systems maypiggyback or parallel the HCF's CATV network, user interface 302 alsoprovides dedicated buttons for switching to and from the CATV network tothe patient surveillance system and/or the patient medical proceduredocumentation system. Status lights 303 are provided for identifying thecurrent system being accessed, e.g., the CATV network or the patientsurveillance network. Additionally, exemplary user interface 302provides a telephone interface for entering textual or numeric data or acombination of the two. Also provided is room lighting control 306 andnurse call button 304 for alerting the nurse's station. Thefunctionality of medical procedure/pillow speaker interface 300 andother types of medical procedure interfaces will become more apparentwith the descriptions of FIGS. 4, 8 and 12 and the process described inthe flowchart depicted in FIG. 11.

FIG. 4 is a diagram of the logical components used in the presentpatient medical procedure documentation system in accordance with stillanother exemplary embodiment of the present invention. Typically, thepresent patient medical procedure documentation system is implemented ina patient surveillance network, which usually comprises at least patientsurveillance sub-system 420 and patient monitoring sub-system 470. Asmay be appreciated, the present patient medical procedure documentationsystem may also be implemented across several physical locations, suchas patient room 400 (containing patient surveillance sub-system 420) andnurse station 450 (containing patient monitoring sub-system 470). Theseparate sub-systems may also be realized in virtually any location inthe healthcare facility, such as the offices for patient administration,billing, medical records and network administration, depending on theduties of the particular location. FIG. 7 is a diagram of an exemplaryhealthcare facility in which the present patient medical proceduredocumentation system may be implemented.

The components that are typically located in patient surveillancesub-system 420, such as patient room 400, include camera control device410 that is usually juxtaposed to television 417, but is not essentialto the practice of the present invention (see FIG. 5). In most patientrooms, television 417 is installed at a central location which is also ahighly advantageous viewpoint location for installing surveillancecamera 416. Additionally, a microphone (not shown) may be disposed onsurveillance camera 416, camera control device 410 or connected as aseparate peripheral for capturing audio in the surveillance area. Hence,for many installations, camera control device 410, television 417 andsurveillance camera 416 are loosely coupled together as a unit (seeagain FIG. 7). In any case, camera control device 410 provides the localprocessing, storage and network connections for the surveillanceperipherals and for the present patient medical procedure documentationsystem. Here it should be mentioned that much of the functionality ofthe present invention may be embodied in a standard personal computer,however, other aspects of the present invention may require supplementalvideo processing and/or storage capacity. Furthermore, as may beappreciated from the description of the set-top box in copending U.S.patent application Ser. Nos. 10/735,307 and 12/151,452, camera controldevice 410 may also have CATV, Internet, PSTN and other capabilitiesthat are not traditionally found in a standard personal computer.

With further regard to camera control device 410, processor unit 411diagrammatically represents all the processing capacity, RAM and ROMmemory, busses and the physical framework for storing and executinginstructions for operating the other components of the control unit.Network controller 412 provides a connection to HCF distribution network440 and to other devices connected to the HCF network, such as nursemonitor device 460 of patient monitoring sub-system 470. Video processor413 comprises any video processing capabilities) necessary forcapturing, processing and/or displaying any video and/or patient medicalprocedure documentation screens. Video processor 413 may be integratedin a general purpose processing system or supplement the videoprocessing capabilities of the general purpose processing system. Assuch, video processor 413 is responsible for receiving the capturedvideo frames from video camera 416, analyzing video for motion (seecopending U.S. patent application Ser. Nos. 10/735,307 and 12/151,452),prioritizing video frames based on content or external factors (such aslabeling the frames as documentation for a patient medical procedure)and compiling medical procedure information screens for display on thelocal monitor, such as TV 417 (see FIG. 10).

Camera control device 410 also comprises receiver/interrogator andmedical procedure remote interface 418 for communicating with a medicalprocedure sensing device (a manual or autonomous remote interface forsensing an event indicative of the commencement of a patient medicalprocedure). Optimally, receiver/interrogator and medical procedureremote interface 418 provides multiple communications ports forconnecting with multiple types of medical procedure sensing devices,e.g., autonomous sensing devices 430, medical procedure remote interface200, medical procedure/pillow speaker interface 300 and/or some type oflegacy interface device. As discussed elsewhere above, the medicalprocedure remote device may operate autonomously (usually by sensing thepresence of an HC professional through autonomous sensing devices 430)or manually by receiving manually invoked communication from a HCprofessional. In either case, the aim is for camera control device 410to receive supplemental information indicative of the commencement (andpossibly termination) of a patient medical procedure. The receipt ofthis information enables camera control device 410 to flag anysubsequently captured A/V data as documentation for the informationindicative of a patient medical procedure. Hence, that A/V data may beprioritized and/or backed up locally for access in the future. To thatend, camera control device 410 comprises at least one nonvolatile memoryfor storing A/V data documentation of a patient medical procedure.

As depicted in FIG. 4, camera control device 410 further comprisesprimary nonvolatile memory 414 and secondary nonvolatile memory 415, forstoring different classes of captured A/V data. The storing operationsof camera control device 410 will be discussed below with regard toFIGS. 8 and 9, however it should be appreciated that surveillance datareceived by camera control device 410 may comprise varying degrees ofimportance. Most surveillance data received by camera control device 410is of relatively low importance. That surveillance data are simplytransmitted to monitoring device 460, in near real time, for temporalmonitoring by an HC professional, such as a nurse at nurse station 450.Since that data has a relatively low priority, it will be the first datato be temporally overwritten by fresher surveillance data received atcamera control device 410. More important surveillance data received bycamera control device 410 may be flagged for further review by an HCprofessional. This type of data might include A/V data that failed to beimmediately transmitted over distribution network 440 due to networkbandwidth or operation issues. Various techniques may be applied to thisdata for achieving a rapid resolution to the problem, such as alarms,frame rate reduction and locally backing up the A/V data.

Another class of data that should be treated separately is surveillancedata relating to patient medical procedures. This type of surveillancedata is associated with information received by receiver/interrogatorand medical procedure remote interface 418 that is indicative of apatient medical procedure. All surveillance data captured within a timewindow of the receipt of patient medical procedure information may betreated as documentary evidence of that patient medical procedure.Hence, surveillance data retained in primary nonvolatile memory 414prior to receiving the patient medical procedure information may beconsidered as documentation of a patient medical procedure.

Before proceeding, it should be mentioned that surveillance A/V data maybe retained in one of several formats. One retention format involvesstoring the sequentially captured images frames as separate image framefiles. Patient procedure information received at patient surveillancesub-system 420 is included in the frame header for corresponding imageframes. This retention format is more useful for streaming video acrossthe HCF distribution network; if documentation of a patient medicalprocedure is needed, each of the image frames must be searched andreturned separately and then combined into a single documentationsurveillance A/V file. A second retention format involves storing all ofthe captured image frames for a particular patient medical procedure asa single surveillance A/V file. The surveillance A/V file is createdupon receiving information indicating that a new patient medicalprocedure is commencing. Video image frames currently in primarynonvolatile memory 414 that were captured within a predetermined timewindow are included in the newly created procedure surveillance A/Vfile. All A/V data captured at patient surveillance sub-system 420 arebound to the procedure surveillance A/V file until an end-of-procedureevent is logged. The end-of-procedure event may be any informationindicative of an end of the patient medical procedure, for instance,receiving a manual command from the HC professional to terminate themedical procedure NV data file, detecting the end of a predeterminedtime period, or by failing to detect any motion in the surveillance areafor a predetermined time period, or any combination of the sub-processesdescribed above. With further regard to either retention format, the aimis to create documentation of a patient medical procedure as a stream ofcontinuous surveillance data that can be easily identified ascorresponding to a particular patient medical procedure.

In any case, it should be appreciated that exemplary nonvolatilememories 414 and 415 may be provided in various configurations, such asseparate memory devices or partitions in a single memory. It should alsobe understood that camera control device 410 should have a nonvolatilememory for storing patient medical procedure NV data for future access.Optimally, primary memory 414 is a nonvolatile memory that is capable ofretaining data in the event of a power loss. However, in accordance withother exemplary embodiments of the present invention, primary memory 414may instead be configured as conventional RAM memory, wherein priorityNV data is copied to a second nonvolatile memory immediately (such assecondary nonvolatile memory 415). While this configuration provides farless security for the priority surveillance NV data, utilizing RAMmemory of nonvolatile flash memory is usually more economical.Additionally, a portion of nonvolatile primary memory 414 may beallocated for use by video processor 413. In this configuration, evensurveillance data being processed by video processor 413 will beretained in the event of a power failure.

Surveillance system 420, including camera control device 410, along withits ancillary and peripheral components, is connect to a variety ofphysical locations (see FIG. 7), wherein the captured surveillance A/Vdata may be monitored, retained or otherwise processed for the HCF.Virtually every surveillance system 420 on HCF distribution network 440will be connected to a patient monitoring sub-system for dedicatedmonitoring (depicted in the figure as patient monitoring sub-system 470or nurses station). In accordance with one exemplary embodiment of thepresent invention, nurse monitor device 460 of patient monitoringsub-system 470 may be configured identically to camera control device410. In that case, nurse monitor device 460 generally comprisesprocessing unit 461 for storing and executing instructions, networkcontroller 462 for connecting to HCF distribution network 440, videoprocessor 463 and nonvolatile memories 464 and 465 for processing and/ordisplaying any captured surveillance data and/or patient medicalprocedure documentation screens. Video processor 463 may be integratedin a general purpose processing system or supplement the videoprocessing capabilities of the general purpose processing system, whichis coupled to video monitor 467 for viewing. Nurse monitor device 460may also be coupled to a surveillance camera (not shown); in that casevideo processor 463 is also responsible for surveillance video capturedas discussed above with regard to video processor 413. Because patientmonitoring sub-system 470 may also be used as a supplemental inputdevice for entering, editing or supplementing the information relatingto a patient medical procedure, patient monitoring sub-system 470 istypically connected to a variety of data entry peripherals, such asmanual interface device 469 (typically a mouse and/or keyboard) and/ortouch screen video monitor 467.

FIG. 5A is a top view of a patient room with the present patient medicalprocedure documentation system in accordance with one exemplaryembodiment of the present invention. Every patient room is required tohave access to a lavatory, which is usually integrated in the room, forinstance lavatory 506. Typically, patient room 400 comprises bed 502,furniture 504, lavatory 506, television 417 and a pillow speaker forlistening to the television and calling the nurse (such as medicalprocedure/pillow speaker interface 300). Located in an optical positionfor viewing the area of patient room 400 containing the patient, usuallythe area including a surrounding bed 502, is surveillance system 420(view angle 520 represents the aspect of video camera 416 which definesthe surveillance area in patient room 400). Surveillance system 420comprises at least video camera 416 and set top box 410 and is usuallyadjacent to television 417.

By law, any room in which a HC professional may come in physical contactwith a patient must also include a hand washing/disinfectant station,depicted as hand cleaning/disinfectant station 510 in the figure andenlarged in FIG. 5B. At a minimum, hand cleaning/disinfectant station510 will include germicidal disinfectant 512, protective gloves 514,wipes 516, usually on a station table 518, or the like, and a wastereceptacle (not shown). Hand cleaning/disinfectant station 510 may belocated in lavatory 506 or elsewhere in patient room 400. As depicted inFIG. 5A, hand cleaning/disinfectant station 510 occupies a mobile cartthat may be repositioned throughout patient room 400 (here handcleaning/disinfectant station 510 is at the foot of bed 502).Furthermore, and in accordance with one exemplary embodiment of thepresent invention, hand cleaning/disinfectant station 510 furthercomprises manual procedure remote 200. Placement of manual procedureremote 200 on or near station table 518 provides the HC professionalwith a means for initiating a medical procedure surveillance A/V file(or any other type of surveillance A/V file) during the disinfectingprocedure (which must be performed prior to interacting with thepatient). Notice in FIGS. 6A and 6B, hand cleaning/disinfectant station510 is depicted as a mobile platform and fixed table adjacent to a wall,respectively.

In accordance with one aspect of the present invention, manual procedureremote 200 presents the HC professional with a relatively clean anduncomplicated interface; the HC professional merely actuates button 202on manual procedure remote 200. Once actuated, manual procedure remote200 sends patient medical procedure information to surveillance system420 that initializes a patient medical procedure surveillance A/V fileor other type of procedure surveillance A/V file. Alternatively, and inaccordance with one exemplary embodiment of the present invention, theHC professional may also initiate a patient medical proceduresurveillance A/V file using medical procedure/pillow speaker interface300 or some other legacy interface device, such as a keyboard or tablet.It should be mentioned that manual procedure remote 200 contains atleast one dedicated manual interface component for initiating a medicalprocedure surveillance A/V file; the HC professional may be required tointeract with a procedure screen displayed on television 417 wheninitiating a medical procedure using legacy input devices and otherinterfaces without a dedicated procedure interface.

FIG. 7 is a diagram an HCF distribution network in which the presentpatient medical procedure documentation system may be implemented inaccordance with an exemplary embodiment of the present invention. HCFdistribution network 440 is coupled between patient rooms 400 andvarious HCF offices, such as nurses stations 450, patient administration745 and system administration 748 via transmission medium 741 (such astwisted pair, coaxial conductor, power conductor, optical fiber, air orany other suitable transmission medium. Camera control device 410 islocated in each patient room 400, as well as any other location thatsurveillance and/or monitoring is desired (such as nurse's station 450)and coupled through a variety of network switches 742 and other routinghardware. As mentioned, the present invention is flexible enough thatfor many applications, general purpose computer 710 (i.e., PC, laptop,handheld, palmtop, or other network device) may replace camera controldevice 410. If broadband access is required, HCF distribution network440 may be connected to broadband connection 743 through networkserver/router/firewall 746. In practice, one or more servers may beconnected to HCF distribution network 440, however at least one networkstorage, HCF network storage 744, should be provided for maintainingpatient and other information, such as patient medical procedure A/Vfiles.

FIG. 8 is a logical diagram that illustrates the flow of surveillancevideo data across surveillance system 420 for documenting patientmedical procedures in accordance with an exemplary embodiment of thepresent invention. The components of surveillance system 420 areessentially identical to those depicted in FIG. 4 with the exception ofprocedure remote interface 800. Interface 800 may be any manual orautonomous remote interface for sensing an event indicative of thecommencement of a patient medical procedure, including but not limitedto, manual procedure remote 200, medical procedure/pillow speakerinterface 300, legacy interface device, transponder key FOB, RFID assetmanagement, Bluetooth or the like. In operation, video camera 416 iscontinually capturing surveillance NV data from the surveillance area ofthe patient room. Video stream 802 is received at video processor 413,which processes the video data as required by service running at videoprocessor 413 and/or processing unit 411. Processed video data 804 exitsvideo processor 413 and is temporarily stored at primary nonvolatilememory 414. One reason for providing primary nonvolatile memory 414 isto provide a nonvolatile buffer for storing image frames prior totransmission across HCF distribution network 440. Network controller 412arbitrates with HCF distribution network 440 for transmission bandwidthand passes transmission video 806 to network controller 412, which is,in turn, output to HCF network 440 as transmitted video 808. Transmittedvideo 808 may be monitored by anyone having the proper authorization andwith access to HCF distribution network 440, and is typically recordedat a central database, such as a medical records database in networkstorage 744.

Primary nonvolatile memory 414 provides a temporary storage forprocessed video 804 during the arbitration and for temporary storageduring high network usage periods and short-lived outages. The moresurveillance video residing in primary nonvolatile memory 414, thegreater the lag time between capturing the surveillance and receivingthe video at a remote monitoring location. If adequate network bandwidthis not allocated to network controller 412, at some point networkcontroller 412 will reduce the frame rate of video frames transmitted toHCF distribution network 440 by skipping every n frames residing inprimary nonvolatile memory 414. Depending on the importance of the nframes in primary nonvolatile memory 414, processing unit 411 mayinstruct video processor 413 to save the video stream (or a portion ofthe video stream) in secondary memory 415. Hence, the presentsurveillance system reduces the likelihood of important surveillancedata being overwritten (see copending U.S. patent application Ser. Nos.10/735,307 and 12/151,452). However, this surveillance protocol does notguarantee that important NV data relating to patient medical proceduresis available to document the medical procedure at a later time.Furthermore, even if the subject medical procedure happened to be saved,the medical record and billing administrator still must review a morassof surveillance video data for documentation for a specific procedure.

Therefore, in contrast to the flow of surveillance video data acrosssurveillance system 420 discussed above, surveillance system 420 createsan alternate video path and protocol for handling surveillance videodata that relates to a patient medical procedure (or any otherprocedure). Here, processor unit 411 receives procedure information 810from procedure remote interface 800 and generates instructions forhandling the upcoming video surveillance data. In accordance with oneexemplary embodiment of the present invention, procedure remoteinterface 800 senses the presence of an HC professional and initiates apatient medical procedure A/V data file with the sensed information.Video processor 413 receives instructions 812 and immediatelyprioritizes any subsequent surveillance data, as well as surveillancedata already retained in primary nonvolatile memory 414 over somepredetermined time window. All prioritized medical proceduresurveillance data 820 is copied to secondary nonvolatile memory 415.Prioritized medical procedure surveillance data 820 will remain insecondary nonvolatile memory 415 until it is overwritten by freshmedical procedure surveillance data. It should be mentioned that anymedical procedure surveillance data 820 residing in secondarynonvolatile memory 415 may be de-prioritized remotely at any time by anauthorized HCF administrator. Medical procedure surveillance data 820provides that HCF with a safety copy of all patient medical proceduresperformed in the surveillance area. Once documentation of a patientmedical procedure is available at HCF medical records database 744, thecorresponding local safety copy of the patient procedure is no longerneeded at secondary nonvolatile memory 415 and can be de-prioritized foroverwriting, or expressly deleted.

Regardless of the existence of a safety copy of the medical proceduresurveillance data 820 in secondary memory 415, the patient medicalprocedure surveillance data in primary memory 414 is forwarded onto HCFnetwork 440 as transmitted video 808 from primary memory 414 asdescribed above. Hence, transmitted video 808 that is also documentationof a patient medical procedure may simultaneously reside in networkstorage 744. The mere existence of this documentation of surveillancesystem 420, while important, does not substantially diminish the task ofsorting video documentation of medical procedures from any other type ofsurveillance data.

Therefore, in accordance with still another exemplary embodiment of thepresent patient medical procedure documentation system, patient medicalprocedure surveillance video is identified as such and transmitted withthe surveillance video sequences. Furthermore, status informationconcerning the subject patient medical procedure, i.e., that informationsensed by local surveillance sub-system 420, is transmitted separatelyto the HCF administrators and billing professionals. This informationprovides the HCF administrators and billing professionals with the mostcomplete and temporal information concerning a patient medicalprocedure. Returning to the diagram depicted in FIG. 8, procedureinformation contained in instructions 812 from processor unit 411 isstripped out and included in the file header(s) for the patient medicalprocedure surveillance data files. Typically, some or all information iscoupled to each video frame prior to storing and/or transmitting(alternatively, the frame headers may contain a pointer to a locationfor the information). However, at some point before, during or after thepatient medical procedure, a data file is transmitted to the networkstorage 744 containing all patient medical procedure information thatwas received at processor unit 411. The existence of this data file atnetwork storage 744 provides valuable information that substantiallyreduces subsequent sort times for obtaining documentation for a patientmedical procedure. Similarly, receipt of this information by the HCFadministrators suggests that a surveillance record of a patient medicalprocedure exists at local surveillance sub-system 420 and, therefore,should be downloaded. At a minimum, the procedure information conveyedto the HCF administrators provides a network address of the source ofthe data and patient medical procedure information that was received atprocessor unit 411. With that information, HCF administrators canschedule a download of the corresponding patient medical surveillancevideo at local surveillance sub-system 420. There, processor unit 411receives instructions for the HCF administrator to begin the download,which in turn authorizes the corresponding patient medical proceduredocumentation video file 822 to transfer across HCF distribution network440, via network controller 412. Upon verification of the successfulreceipt of patient medical procedure documentation video file 822, theHCF administrator authorizes surveillance system 420 to de-prioritize ordelete the corresponding surveillance file in secondary nonvolatilememory 415.

FIGS. 9A and 9B are a flowchart of a process for documenting patientmedical procedures using a surveillance system in accordance with anexemplary embodiment of the present invention. Essentially, the presentpatient medical procedure documentation system involves operating thelocal surveillance sub-system in a predefined surveillance state, suchas routine surveillance, motion-detected surveillance, proceduresurveillance, medical procedure surveillance, etc. Surveillance datacaptured by the local surveillance sub-system are prioritized forstorage in local memory and for transmission across HCF distributionnetwork based on the current surveillance state of the localsurveillance sub-system. One surveillance state of particular interestis defined for documenting patient medical procedures. When the localsurveillance sub-system operates in this state, the capturedsurveillance data is prioritized and copied to a nonvolatile secondarymemory for safety, in addition to the normal transmission over the HCFdistribution network. The safety copy of the surveillance data stored ina secondary memory can be perused by any authorized HCF personnel anddownloaded to a central HCF database during off-peak hours when networkusage is low.

The present patient medical procedure documentation method is aniterative process which reiterates after each captured image frame isreceived at camera control device 410 (step 902). Initially, the systemchecks for any new information that may change the current surveillancestate, modifies it, or provides supplemental information concerning thecurrent surveillance state (step 904). This new procedure informationmay come from any of a variety of procedure remote interfaces, eitherlocal manual and autonomous sensing devices as discussed above. If nonew procedure information has been received at local surveillancesub-system 420, the current procedure information is bound to the newcaptured image frame header (step 914) and that image frame overwriteslower priority and/or older data in the primary nonvolatile memory (step916). Consecutive video image frames of the same type may be boundtogether in a single surveillance A/V file. The surveillance A/V file isthen prioritized based on the type of surveillance data contained in thesurveillance A/V file, for instance a routine surveillance file willhave a very low priority, while surveillance data with motion detectedwill have a higher priority and patient medical procedure surveillancewill also have a high priority. Newer and higher priority A/Vsurveillance data will take precedence over older and lower prioritysurveillance A/V data in the local memory.

Returning to step 904, if any new procedure information has beenreceived subsequent to capturing the previous image frame that datashould be tested to determine if the data is indicative of a new patientmedical procedure or is supplemental information to an ongoing patientmedical procedure (step 906). Typically, the present patient medicalprocedure documentation system operates in a patient proceduresurveillance state or some other surveillance state having a lowerpriority. At the termination of one surveillance state, localsurveillance sub-system 420 creates and transmits an end-of-proceduredata file that signals the termination of the current patient procedure.The end-of-procedure data file contains the most temporal procedure datareceived by local surveillance sub-system 420. The end-of-procedure filemay also contain a log of all procedure information received at thelocal surveillance device during the current patient procedure; thisadditional information increases search efficiency for a particularpatient procedure.

It is sometimes difficult to determine whether or not a completely newmedical procedure is to commence based solely on the procedureinformation received at camera control device 410 of local surveillancesub-system 420. For instance, if present patient medical proceduredocumentation system is operating in one patient procedure surveillancestate and it senses the presence of a new HC professional in thesurveillance area, there is a tendency to change patient proceduresurveillance states, that is, to create a new patient proceduresurveillance file based solely on the presence of the new HCprofessional in the surveillance area. The occurrence of this situationis more likely whenever a current patient procedure surveillance file isnot manually terminated, but instead the present patient medicalprocedure documentation system relies on the expiration of a time periodto terminate a patient procedure surveillance state (with or withoutsensing motion in the surveillance area). In this situation, the presentpatient medical procedure documentation system must either autonomouslyterminate the current patient procedure surveillance file and create anew patient procedure surveillance file for the new HC professional, orsimultaneously write patient procedure files for two procedures (i.e.,operate in two surveillance states simultaneously). Because memory spaceat the local surveillance sub-system is at a premium, duplicativesurveillance A/V files cannot be permitted. A better solution is tosimply include any newly sensed procedure information in the currentprocedure data file (and/or in the header of the current image frame).This may sometimes result in two different patient procedures beingbound in the same patient surveillance A/V file. In that event,subsequent searches for either patient procedure can be resolved by thedifferences in the original procedure data and the supplementalprocedure data, both sets of data may be included in all image frameheaders subsequent to receiving the supplemental procedure data.Additionally, the end-of-procedure data file will usually contain a datalog of all procedure events that were sensed during the patientprocedure; that log will provide enough information to suggest thepossibility of surveillance A/V data for two separate patient medicalprocedures.

In any case, if the new procedure information received by localsurveillance sub-system 420 is merely supplemental procedureinformation, the current procedure data file retained in memory ismodified with the new procedure data (step 912) and that data are boundto the frame header of the current image frame i.e., the newly capturedimage frame (step 914). At this point, the current image frame (andheader information) overwrites lower priority and/or older data in theprimary nonvolatile memory (step 916).

If, on the other hand, the newly received procedure informationrepresents the commencement of an entirely new patient medical procedure(step 908), the present patient medical procedure documentation systemcreates a new procedure data file for the new procedure information(step 910) and then initiates a new procedure surveillance A/V file forthe newly captured image frame and all subsequent frames until anend-of-procedure determination is made (step 910). The new proceduresurveillance A/V file is given a high priority to avoid inadvertentoverwriting of the surveillance A/V data in the primary nonvolatilememory. Next, the new procedure data are bound to the frame header ofthe newly created image frame (step 914) and the newly created imageframe and header information overwrites lower priority and/or older datain the primary nonvolatile memory (step 916).

Next, the present patient medical procedure documentation system teststhe current A/V file to determine if it is a high priority proceduresurveillance A/V file (step 920). If the file is confirmed to be a highpriority procedure surveillance A/V file, the current image frame andheader information is copied to the corresponding procedure surveillanceA/V file open in the secondary Memory (step 922). If the current imageframe if the first frame for a new patient procedure, then the presentpatient medical procedure documentation system creates a new proceduresurveillance A/V file in the secondary memory and copies the currentimage frame and header information to that file.

At some point, the present patient medical procedure documentationsystem will detect an event that signals the end of the ongoing patientprocedure (step 924), for instance local surveillance sub-system 420receives a manual termination request from the HC professional presentfor the procedure or a predetermined time period expires. If the patientprocedure has not ended, the process invokes a network transmissionroutine (see steps 928-932 discussed below). Alternatively, if thepresent patient medical procedure documentation system detects the endof the patient procedure, an end-of-procedure data file is created thatwill be sent to the HCF medical records and billing administrators atthe first opportunity HCF distribution network 440 is accessible (step926). The end-of-procedure file is of particular importance as itcontains an event log of all procedure events that occurred during thepatient procedure. The end-of-procedure file also alerts the HCF medicalrecords and billing administrators to the presence of a surveillance A/Vfile stored in the secondary memory of local surveillance sub-system420. With this information, the patient billing professionals canschedule download of procedure surveillance A/V data that documents thecorresponding patient medical procedure.

Next, a network transmission routine is invoked for transmitting thecurrent image frame over distribution network 440. Initially, networkcontroller 412 attempts to access the HCF distribution network (step928). If the network is unavailable, the process reverts to step 902 forreceiving another captured image frame. Because both the current imageframe and any new procedure information are temporarily stored in theprimary nonvolatile memory, those files can be transmitted in the nextiteration of the process. Hence, once the network is accessible to localsurveillance sub-system 420, any new procedure data files aretransferred (step 930) as well as all image frames and theircorresponding headers (step 932). It should be mentioned that betweendata transfers network controller 412 checks the backlog in the primarymemory. If a bottleneck of surveillance image data is occurring, thecontroller will invoke a transfer method to reduce lag time, such aslower the frame transfer rate, or merely skipping a group of lowerpriority image frames. In either case, network controller 412 may make atemporary local copy of the surveillance file that can be accessed by HCprofessionals at monitoring sub-system 460.

FIG. 10 is an illustration of a patient procedure screen for the presentpatient medical procedure documentation system that may be accessed byauthorized HC professionals in accordance with an exemplary embodimentof the present invention. Initially, it should be mentioned that some orall of procedure form 1000 may be displayed and completed beforehand bythe HCF processional performing the patient procedure or any otherauthorized HCF processional (such as a nurse or other HCFadministrator). Upon scheduling a patient procedure, procedure form 1000is generated at a remote location, for instance nurse station 450, andincludes all of available information related to the patient procedure,e.g., at least the patient information 1010 and procedure information1030, i.e., procedure name, billing code, etc. The entry fields ofprocedure form 1000 are completed by the HC professional using a PC,tablet, nurse monitor device 460 or any other device connected to HCFdistribution network 440. Alternatively, present patient medicalprocedure documentation system generates procedure form 1000 at thelocal surveillance area, such as patient room 400, either in response toa manual interaction from a HC professional (for instance by usingprocedure remote 200, medical procedure/pillow speaker interface 300 ora legacy input device in communication with camera control device 410 oflocal surveillance sub-system 420) or autonomously (for instance by thecamera control device 410 of local surveillance sub-system 420 sensingthe presence of an HC professional within the range of medical procedureremote interface 418). Procedure form 1000 contains a log of all patientprocedure information that will be included in the end-of-procedurefile. Recall that the end-of-procedure file is transmitted at theconclusion of the patient procedure. Many of the entry fields inprocedure form 1000 may be entered, edited or sublimated at the localsurveillance area using medical procedure/pillow speaker interface 300or some other legacy interface device, such as a keyboard or tablet thatis in communication with local surveillance sub-system 420. Optimally,the present patient medical procedure documentation system automaticallycompletes as many fields as possible in order to reduce the workload onthe HC professional performing the patient procedure.

Whether procedure form 1000 is filled automatically or manually, theform is largely auto-fill, wherein the system recognizes certaininputted information and then auto-fills all related entry fields. Forexample, in response to a patient name being entered, the presentpatient medical procedure documentation system brings up and fills inthe remainder of patient information 1010. Information forDate/Time/Room fields 1020 is provided by local surveillance sub-system420 and the entry fields may be un-editable to HC professionals.

One aim of procedure form 1000 is to provide a simplified page forentering patient procedure information. In practice, a new procedureform will be automatically created for each instance that localsurveillance sub-system 420 senses the presence of a HC professional.For example, notice from the content of auto detection field 1040 thatlocal surveillance sub-system 420 has detected the presence of McKinney(FOB 0421), Jones (FOB 9101) and Henderson (FOB 2211). Here,receiver/interrogator and medical procedure remote interface 418 hasdetected three FOBs within its range and interrogated them to producethe identities of their owners and their positions in the HCF. Inresponse, the present patient medical procedure documentation systemgenerates a new procedure form 1000 in anticipation of an upcomingpatient medical procedure.

In certain situations, the present patient medical proceduredocumentation system will generate a bogus procedure form 1000 that doesnot document any patient medical procedure merely due to the presence ofHC professionals being detected within the range of medical procedureremote interface 418. The surveillance A/V files that do not correlateto a procedure are eventually discarded by the HCF medical records andpatient billing professionals. Some of these bogus surveillance A/Vfiles can be identified as such by the HC professional present in thesurveillance area. Notice directly to the right of the HC professionalidentities in procedure form 1000 is an entry field for each of the HCprofessional's duty or status for the current patient procedure. In theexample procedure form, McKinney is listed as the Primary attending incharge of the patient medical procedure and Jones is listed as a Witnessto the procedure. Notice however, that Henderson has been detected byreceiver/interrogator and medical procedure remote interface 418, but isnot actually present for the procedure. Medical procedure remoteinterface 418 detects any HC professionals within its range, so any HCprofessionals that are detected but not present must be documented onprocedure form 1000. Hence, the procedure information for any bogussurveillance A/V files wherein an HC professional is not in thesurveillance area can be amended to show that the detected professionalis Not Present. Conversely, manual entry fields 1050 are provided formanually entering any HC professionals that are present in thesurveillance area but not detected by medical procedure remote interface418.

With further attention to procedure form 1000, procedure informationfields 1030 identify the patient procedure being performed sufficientlyfor identifying any documentation to the procedure, such as acorresponding surveillance A/V data file. Information for procedureinformation fields 1030 must be entered manually, however, may be empty.In that case, the HCF medical records and patient billing professionalsmust identify the patient procedure that correlates to the particulardocumentation surveillance A/V file. This process is greatly aided bythe receipt of an end-of-procedure data file that is generated by thepresent patient medical procedure documentation system at the conclusionof a procedure.

FIG. 11 is a flowchart of a process for collecting the documentationsurveillance A/V files corresponding to a patient medical procedure inaccordance with an exemplary embodiment of the present invention. Recallthat immediately upon local surveillance sub-system 420 sensing thepresence of a HC professional, a copy of subsequently capturedsurveillance A/V data is copied to secondary nonvolatile memory 415 forsafety. Local surveillance sub-system 420 transmits an end-of-proceduredata file across HCF distribution network 440 once the patient medicalprocedure is terminated. The present method is an iterative processrunning on a HCF network device, such as HCF network server 746, thatconstantly listen for end-of-procedure messages on HCF distributionnetwork 440. When HCF network server 746 receives an end-of-proceduremessage (step 1102), the present patient medical procedure documentationsystem opens the message for the identity of the local surveillancesub-system that generated the file and reads any other patient proceduredata that may be present in the end-of-procedure message, such as theidentities of HC professionals present, information concerning thepatient medical procedure, patient information, etc. (step 1104). Theend-of-procedure message will typically also identify the correspondingdocumentation surveillance A/V file with a unique file identifier. Withthis information, the present patient medical procedure documentationsystem can either attempt to immediately download the correspondingpatient surveillance A/V file from the particular local surveillancesub-system 420 or schedule a download attempt in the future (step 1106).It is expected that during regular business hours, HCF distributionnetwork 440 may not have sufficient bandwidth to support downloads ofmultiple documentation surveillance A/V files and, therefore, thepresent patient medical procedure documentation system schedules alldownload attempts for nonpeak hours. If one attempt to retrieve adocumentation surveillance A/V file fails, (step 1108) the processreverts to step 1106 and a subsequent download time is scheduled. If atstep 1108, the documentation surveillance A/V file is successfullydownloaded to HCF network server 746 from local surveillance sub-system420, the documentation surveillance A/V file is stored to an HCF networkdevice, such as HCF network storage 744 (step 1110). The copy of thesurveillance A/V file residing in local surveillance sub-system 420 isde-prioritized in memory, thereby freeing up memory space in secondarynonvolatile memory 415 for higher priority data (step 1112).

Any time a patient's medical procedure requires further documentation,i.e., for patient billing, routine monitoring of performance of HCprofessionals, etc., a copy of the corresponding patient proceduresurveillance A/V file should be present in a centralized location in theHCF, such as HCF network storage 744. Documentation for the patientprocedures can be accessed at will. FIG. 12 is a flowchart illustratinga process for documenting patient medical procedures using surveillanceA/V files corresponding to the patient medical procedure in accordancewith an exemplary embodiment of the present invention. The processbegins with the present patient medical procedure documentation systemreceiving a request for documentation of a patient medical procedure(step 1202). Typically, the request identifies both the patient and theprocedure and usually the date that the procedure was performed and theattending HC professional(s) (step 1204). Using the patient name,procedure identification, date and attending HC professional(s), the HCFdatabase is queried for the documentation (step 1206). If a surveillanceA/V file exists in the HCF database for the procedure, documentation iscreated for the request (step 1226). The documentation is usually in theform of an A/V file that is appended to the request, but might insteadbe only a link or address to the file on the HCF database. As discussedabove, not all surveillance A/V files contain all of the procedureinformation contained in the request, hence, fulfilling the request mayrequire some review by an HCF administrator. At a minimum, everysurveillance A/V file will contain the patient name and room number, andthe identity of at least one HC professional. Therefore, if at step1208, a surveillance A/V is not returned that correlates to the requestdata, the database may be queried by patient and date for all proceduresurveillance A/V files (step 1210). Those files are reviewed by an HCprofessional of the subject of the request. If the requested patientprocedure is identified, the process reverts to step 1226 anddocumentation for the patient procedure is created. If not, the searchof the HCF database is broadened for a search for all surveillance A/Vfiles for all procedures performed on the subject patient (step 1214).This requires substantially more review by the HC professional, but muchless than search all surveillance data for the patient. If the fileexists (step 1216), the process reverts to step 1226 and documentationfor the patient procedure is created. If no documentation for theprocedure can be identified from the HCF database, it is possible thatthe surveillance A/V file is present at the local surveillancesub-system. In that case, the patient name and room number at the dateof the procedure is gathered (step 1218) because the documentation filemay still exist on the secondary nonvolatile memory of the localsurveillance sub-system for the patient room. The local surveillancesub-system 420 is accessed for the surveillance A/V file (step 1220) andif it exists locally (step 1222) the process reverts to step 1226 anddocumentation for the patient procedure is created. A copy is alsoretained at the HCF database. If no documentation can be identified, anerror is returned and the HC professionals begin the task of searchingall surveillance data associated with the identified patient.

The exemplary embodiments described below were selected and described inorder to best explain the principles of the invention and the practicalapplication, and to enable others of ordinary skill in the art tounderstand the invention for various embodiments with variousmodifications as are suited to the particular use contemplated. Theparticular embodiments described below are in no way intended to limitthe scope of the present invention as it may be practiced in a varietyof variations and environments without departing from the scope andintent of the invention. Thus, the present invention is not intended tobe limited to the embodiment shown, but is to be accorded the widestscope consistent with the principles and features described herein.

The flowchart and block diagrams in the Figures illustrate thearchitecture, functionality, and operation of possible implementationsof systems, methods and computer program products according to variousembodiments of the present invention. In this regard, each block in theflowchart or block diagrams may represent a module, segment, or portionof code, which comprises one or more executable instructions forimplementing the specified logical function(s). It should also be notedthat, in some alternative implementations, the functions noted in theblock may occur out of the order noted in the figures. For example, twoblocks shown in succession may, in fact, be executed substantiallyconcurrently, or the blocks may sometimes be executed in the reverseorder, depending upon the functionality involved. It will also be notedthat each block of the block diagrams and/or flowchart illustration, andcombinations of blocks in the block diagrams and/or flowchartillustration, can be implemented by special purpose hardware-basedsystems which perform the specified functions or acts, or combinationsof special purpose hardware and computer instructions.

The terminology used herein is for the purpose of describing particularembodiments only and is not intended to be limiting of the invention. Asused herein, the singular forms “a”, “an” and “the” are intended toinclude the plural forms as well, unless the context clearly indicatesotherwise. It will be further understood that the terms “comprises”and/or “comprising,” when used in this specification, specify thepresence of stated features, integers, steps, operations, elements,and/or components, but do not preclude the presence or addition of oneor more other features, integers, steps, operations, elements,components, and/or groups thereof.

What is claimed is:
 1. A surveillance device for documenting patientprocedures comprising: a surveillance camera for capturing a pluralityof video frames of a surveillance area; a patient procedure remote fordetecting the presence of a healthcare professional proximate to thesurveillance area and in response, generating a procedure indication;and a surveillance control device comprising: a primary nonvolatilememory; a secondary nonvolatile memory; medical procedure remoteinterface for receiving a procedure indication from the patientprocedure remote and generating procedure information from the procedureindication; a video processing unit coupled to the surveillance camerafor processing video frames captured by the surveillance camera andstoring the processed video frames in the primary nonvolatile memory,and in response to receiving procedure information from the medicalprocedure remote interface, attaching at least some of the procedureinformation to the video frames subsequently stored in the primarynonvolatile memory and copying the video frames subsequently stored inthe primary nonvolatile memory to the secondary nonvolatile memory; anetwork controller coupled to a healthcare facility distribution networkfor obtaining processed video frames from the primary nonvolatile memoryand transmitting the processed video frames across the healthcarefacility distribution network; and wherein the patient procedure remoteincludes a legacy interface for receiving generic manual interactionsfrom a healthcare professional that may be correlated to a patientprocedure.
 2. The surveillance device recited in claim 1, wherein thelegacy interface includes at least one of a manual actuator, switch,lever, knob, touch pad and button for receiving manual interactions froma healthcare professional.
 3. The surveillance device recited in claim1, wherein the legacy interface includes at least one of a biometricsensor, voice recognizer, fingerprint reader, whole hand scanner,iris/retina recognizer, for receiving biometric interactions from ahealthcare professional.
 4. The surveillance device recited in claim 1,wherein the legacy interface for receiving generic manual interactionsfrom a healthcare professional includes at least one of a mouse,pointer, trackball, keyboard, touchpad and touch screen.
 5. The methodrecited in claim 4 above, wherein the procedure indication is anidentity of a healthcare professional and attaching information relatedto a patient procedure to each of the plurality of subsequent videoframes further comprises: attaching the identity of the healthcareprofessional to each of the plurality of subsequent video frames.
 6. Thesurveillance device recited in claim 1, wherein the patient procedureremote is a pillow speaker with a multitasking manual interface forreceiving manual interactions from a healthcare professional.
 7. Thesurveillance device recited in claim 1, wherein the patient procedureremote is a hardware token in the possession of a healthcareprofessional.
 8. The surveillance device recited in claim 7, wherein thehardware token is an automated electronic security token comprising oneof a transponder key FOB, RFID tag, Bluetooth wireless interface, WIFIinterface.
 9. The surveillance device recited in claim 1, wherein theprimary nonvolatile memory and the secondary nonvolatile memory areseparate partitions in a nonvolatile memory.
 10. The surveillance devicerecited in claim 1, wherein the secondary nonvolatile memory is one of ahard drive, optical drive and solid state drive.
 11. A method fordocumenting patient procedures in a surveillance device, where in thesurveillance device comprising a surveillance camera, a patientprocedure remote, a surveillance control device comprising a primarynonvolatile memory, a secondary nonvolatile memory, a medical procedureremote interface, a video processing unit, a network controller coupledto a healthcare facility distribution network, said method comprising:receiving a plurality of video frames from the surveillance camera;storing each of the plurality of video frames in the primary nonvolatilememory; transmitting the at least some of the video frames across thehealthcare facility distribution network; detecting a presence of ahealthcare professional proximate to a surveillance area; receiving aplurality of subsequent video frames from the surveillance camera;delineating each of the plurality of subsequent video frames asprocedure documentation video frames, the delineating includingprioritizing each of the plurality of procedure documentation videoframes in the primary nonvolatile memory; storing the plurality ofprocedure documentation video frames in the primary nonvolatile memory;copying the plurality of procedure documentation video frames in theprimary nonvolatile memory to the secondary memory; and transmitting atleast some of the plurality of procedure documentation video frames inthe primary nonvolatile memory across the healthcare facilitydistribution network.
 12. The method recited in claim 11 above, whereindelineating each of the plurality of subsequent video frames asprocedure documentation video frames further comprises attachinginformation related to a patient procedure to each of the plurality ofprocedure documentation video frames.
 13. The method recited in claim 12above, wherein delineating each of the plurality of subsequent videoframes as procedure documentation video frames further comprisesdelineating each of a second plurality of video frames stored in theprimary nonvolatile memory prior to detecting the presence of ahealthcare professional as a procedure documentation video frame. 14.The method recited in claim 12 above, further comprises: detecting anend to the patient procedure; gathering information concerning thepatient procedure; enclosing the information concerning the patientprocedure in an end-of-procedure message; and transmitting theend-of-procedure message across the healthcare facility distributionnetwork.
 15. The method recited in claim 12 above, wherein detecting apresence of a healthcare professional proximate to a surveillance areafurther comprises: receiving a procedure indication from the patientprocedure remote.
 16. The method recited in claim 12 above, whereindetecting a presence of a healthcare professional proximate to asurveillance area further comprises: receiving procedure informationfrom the patient procedure remote.
 17. The method recited in claim 16above, wherein attaching information related to a patient procedure toeach of the plurality of subsequent video frames further comprises:attaching the procedure information from the patient procedure remote toeach of the plurality of subsequent video frames.
 18. The method recitedin claim 12 above, wherein the procedure indication is in response to amanual interaction between the healthcare professional and the patientprocedure remote.
 19. The method recited in claim 12 above, wherein theprocedure indication is in response to an automated manual interactionbetween the healthcare professional and the patient procedure remote.20. The method recited in claim 12 above, further comprising: receivinga request for wherein the procedure indication is in response to amanual interaction between the healthcare professional and the patientprocedure remote.